EFFICIENCY AND TRANSPARENCY IN PRICING

Transcription

1 1 EFFICIENCY AND TRANSPARENCY IN PRICING SHANG-PING CHEN RESEARCHER DIVISION OF MEDICAL REVIEW AND PHARMACEUTICAL BENEFITS NATIONAL HEALTH INSURANCE ADMINISTRATION (NHIA), TAIWAN 2014/10/31

2 Outline 2 Drug Expenditures Statistics Drug Payment System Pharmaceutical Benefits and Reimbursement Schedule (PBRS) Drug Listing and Pricing Rules Challenge and conclusion

3 2011 Total Health Expenditure per Capita (US$ purchasing power parity-adjusted) Resource: OECD website 3

4 Trend of NHI Drug Expenditures % % 24.8% 24.4% 24.6% 24.9% 24.8% 25.0% 24.8% 25.2% 25.4% 25.0% 25.8% 25.1% % 25.0% $ billion price cut price cut 3.1% 2.2% % 31.5 price cut % price cut price cut price cut 4.4% 2.4% 1.4% price cut price cut 6.9% 5.3% 8.4% price cut 8.6% 20.0% 15.0% 10.0% 5.0% % 0.9% -0.3% 0.0% drug expenditure drug expenditure over total health care expenditure (%) growth rate -5.0% 4

5 5 Analysis of the Drug Expenses (2012) Classification Subgroup Drug expenditure ($ million) Percentage Antineoplastic agents % Catastrophic disease Drugs used in blood disease % Drugs used in mental illness % others % subtotal % Antihypertensive drugs % Outpatient Chronic disease Drugs used in diabetes % Lipid modifying agents % others % subtotal % Others subtotal % Total %

6 Drug Payment System 6 Reimbursement for drugs is uniform nationwide and paid to the medical institution Fee-for-service Reimbursement price per item* volumes prescribed Package payment Per diem Chinese Medicines ($30 NTD per day) Clinics and Pharmacies ($22 NTD per day, up to 3 days)

7 Outpatient Co-payment for Drugs 7 Drug fee Co-payment (NTD) Drug fee Co-payment (NTD) <=$100 NTD 0 $601~700 $120 $101~200 $20 $701~800 $140 $201~300 $40 $801~900 $160 $301~400 $60 $901~1000 $180 $401~500 $80 >=$1001 $200 $501~600 $100 Exemption: 1. Refillable prescriptions for patients with chronic illnesses 2. Dental services 3. Case payment services

8 Principle of medication policy 8 Early access Pay for value Equal access Patient-oriented health care

9 2 nd generation NHI 9 Implemented in 2012 More transparent and predictive Pharmaceutical Benefits and Reimbursement Schedule (PBRS) as the principle for drug listing and fee schedule PBRS Joint Meeting composed of stakeholders to ensure decision making for drug listing and reimbursement

10 Difference between 1 st & 2 nd 10 generation NHI Decision making 1 st generation NHI 2 nd generation NHI New drugs Expert committee PBRS Joint Meeting (stakeholder committee) New items (same ingredient/function with existent drugs/medical devices) HTA Price decided by the insurer Starting from 2007 by CDE Price suggested by the insurer then decided by PBRS Joint meeting The NIHTA is established in 2013

11 Mission of PBRS Joint Meeting 11 Make rules of drug listing Make principles of PBRS Decide to list & reimburse new drugs & medical devices Decide to list & reimburse new items with same ingredients or function of existing drugs or medical devices Review extension or change of existing PBRS items Other issue related to PBRS 11

12 Members of PBRS Joint Meeting 12 Healthcare providers pharmacist, 1 healthcare provider, 8 health authority, 1 medicine authority, 1 Scholars and experts, 5+4 from 2014 Medical experts dentist, 1 Chinese medicine, 1 physician association, 1 hospital association, 1 employer, 3 lay member, 3 The insured

13 How to be a member? 13 Health and medicine authority assigned by competent authorities Scholars and experts designated by insurer The Insured (employer and lay member) recommended by related association then designated by insurer Healthcare provider Pharmaceutical industry assigned by related association 3 representatives may assigned by related association to seat in the PBRS Joint Meeting (although they have no right to vote for cases)

14 Transparency of decision making (1) 14 Drug companies representatives are allowed to make presentations at the Expert Advisory Meeting. Results of the initial review will be sent to the drug companies as well. PBRS Joint Meeting is composed of stakeholders and with three representing pharmaceutical industries sitting in. The agenda of the PBRS Joint Meeting and HTA report is made public 7 days before it meets.

15 Transparency of decision making (2) 15 After meeting, the minutes, sound records, and interest disclosure declarations will be post on the NHIA website. If the suppliers did not agree with the preliminary price concluded by PBRS joint meeting, they can appeal for appraisal to give presentations at PRBS Joint Meeting before listing.

16 16 Listing and Pricing Rules Around 16,700 items get listed by 2014

17 Factors of listing 17 Safety Efficacy TFDA Relative effectiveness Budget impact analysis CBA/CEA/PE Ethical/Legal/Social/Political Impact NHIA

18 Pricing for brand drugs 18 1 Category Pricing Mark-ups Breakthrough Median price of A-10 countries local clinical trials (10%) local pharmaco-economic 2A Me-better 2B Me-too Capped at A-10 median price lowest price in A10 price in original country international price ratio treatment-course dosage ratio a combination drug is priced at 70% of the sum of each ingredient s price, or at the price of the single active ingredient. study (up to 10%) better therapeutic effects (up to 15%) greater safety (up to 15%) more convenient (up to 15%) pediatric preparations with clinical implications (up to 15%)

19 A-10 reference countries 19 Country Source of Reference Pricing Structure US Red Book (not official publication) Wholesale price Japan UK Drug price baselines (official website) NHS Prescription Service (official website) Ex-factory price + wholesale premium + drugstore premium + value-added tax Ex-factory price + wholesale premium Canada Saskatchewan Formulary (official website) Wholesale price Germany France Belgium Sweden Switzerland Australia ROTE LISTE (official website) Base des Médicaments et Informations Tarifaires (official website) Centre Belge d'information Pharmacothérapeutique (official website) Farmaceutiska specialiteter i Sverige (official website) Arzneimittel kompendium der schweiz (official website) Pharmaceutical Benefits Scheme (official website) Ex-factory price + wholesale premium + drugstore premium + value-added tax Ex-factory price + wholesale premium + drugstore premium + value-added tax Ex-factory price + wholesale premium + drugstore premium + value-added tax Wholesale price + drugstore premium Ex-factory price +logistics premium (shared by wholesalers and drugstores) + value-added tax Ex-factory price + wholesale premium + drugstore premium + dispensing fees

20 Pricing for generics 20 For the 1 st generic * BA/BE generic 90% of the price of originator * General generic 80% of the price of originator The 2 nd forward generics are priced at the lowest price of the same category of generics. Add incentives to drugs comply with PIC/S GMP and other quality conditions

21 Pharmaceutical listing & pricing flowchart Timeline All submission before 15 th in even month will be reported at next PBRS meeting PBRS meeting held at the 3 rd Thursday every 2 months and announced agenda 7 days before meeting Drug listing finalized by day15 th next month after meeting and activated at 1 st day after the next month Timeline HTA provided in 42 days after submission Advisory meeting held at the 1 st Thursday every month PBRS meeting held at the 3 rd Thursday every 2 months and announced agenda 7 days before meeting Drug listing finalized in 2wks after PBRS meeting 21

22 Difference of reviewing results 22 1 st NHI 2012 Expert committee (items) Agree Disagree Total 66 (85.7%) 11 (14.3%) 77 (100%) 2 nd NHI PBRS Joint meeti ng 2013 Expert committee (items) Agree Disagree Total Agree (71.9%) Disagree (28.1%) Total 45 (78.9%) 12 (21.1%) 57 (100%) PBRS Joint meeti ng 2014 (Jan.~Aug.) Expert committee (items) Agree Disagree Total Agree (86.4%) Disagree (13.6%) Total 61 (92.5%) 5 (7.5%) 66 (100%)

23 Price of new drugs compared with A reference countries A-10 medium price A-10 lowest price 111% 100% 79.46% 94.43% 83.51% 72.07% 89.66% 58.94% 1 (N=1) 2A (N=8) 2B (N=8) Total (N=17) New drugs listed during 2013/1/1~2014/06/01, not including domestic and those new drugs at self-cut price 39

24 Challenges 24 Process control of PBRS Joint Meeting Reallocation of global budget and budget impact concern from healthcare providers Unbalance of medical information between representatives of the insured and healthcare provider

25 Conclusions 25 Multiple participation Involve more stakeholders to join PBRS Joint Meeting Increase transparency Announced agenda and HTA report before PBRS Joint Meeting Introduce budget impact analysis Through implementing HTA to determine budget impact for reasonable reallocating resources

26 衛生福利部中央健康保險署 26